Medicare Poised to Cover Direct Audiologist Services Starting 2027, Simplifying Hearing Care Access

This bill, the Medicare Audiology Access Improvement Act of 2025, aims to make hearing and balance care more straightforward for Medicare beneficiaries. Starting January 1, 2027, it officially adds audiology services to the list of things Medicare Part B covers when provided by a qualified audiologist (amending Section 1861(s)(2) of the Social Security Act). The core change? Qualified audiologists will be able to offer and bill Medicare directly for hearing and balance assessment and treatment services, without requiring patients to be under a physician's care or supervision for those specific services (as defined in Section 1861(ll)).

Direct Access: Cutting the Red Tape for Hearing Care

So, what does this mean for you or someone you know on Medicare? Currently, accessing specialized audiology care often involves getting a referral from a physician. This bill streamlines that process. From 2027, if you need a hearing assessment or specific balance treatments covered by Medicare, you could go directly to a qualified audiologist. Think of it like seeing some other specialists – the audiologist manages that specific care independently. The bill defines these services (Section 1861(ll)) to include standard hearing and balance assessments and, crucially from 2027, diagnostic or treatment services an audiologist is licensed to provide, which would normally be covered if a doctor did them.

How the Costs Shake Out

When it comes to payment, the bill lines things up with typical Medicare Part B coverage. For these audiology services, Medicare will pay 80% of either the actual charge or the amount set by the Medicare fee schedule, whichever is less (Section 1833(a)(1)). Patients would be responsible for the remaining 20%, similar to other outpatient services. Importantly, qualified audiologists are added to the list of providers who must accept Medicare's approved amount as full payment (payment on assignment-related basis, Section 1842(b)(18)(C)), which helps keep out-of-pocket costs predictable for beneficiaries.

Boosting Access in Underserved Areas

Recognizing that access isn't just about what's covered but where it's covered, the bill also designates qualified audiologists as practitioners eligible to provide services in Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) (Section 1861(aa)(1)(B)). This could be a significant improvement for folks in rural or medically underserved areas, potentially bringing specialized hearing and balance care closer to home by integrating it into community clinics. It's worth noting, however, that the bill explicitly states it doesn't expand the types of audiology services covered beyond what Medicare already allows as of the end of 2026; the focus is on improving access and simplifying the delivery of existing covered services.